With the incidence of breast cancer steadily rising, it is important to explore novel technologies that can allow for earlier detection of disease as well more a personalized and effective treatment approach. The concept of “liquid biopsies” and the data they provide have been increasingly studied in the recent decades. More specifically, circulating tumor DNA (ctDNA) has emerged as a potential biomarker for various cancers, including breast cancer. While methods such as mammography and tissue biopsies are the current standards for the detection and surveillance of breast cancer, ctDNA analysis has shown some promise. This review discusses the versatility of ctDNA by exploring its multiple emerging uses for the management of breast cancer. Its efficacy is also compared to current biomarkers and technologies.
Background Abdominal arterial calcification (AAC) is common among candidates for kidney transplant. The aim of this study is to correlate AAC score value with post‐kidney transplant outcomes. Methods We modified the coronary calcium score by changing the intake data points and used it to quantitate the AAC. We conducted a retrospective clinical study of all adult patients who were transplanted at our center, between 2010 and 2013, and had abdominal computed tomography scan done before transplantation. Outcomes included mortality, pulse pressure (PP) measured by 24 h ambulatory blood pressure monitoring system, and kidney allograft function measured by iothalamate clearance. Results For each 1000 increase of AAC score value, there is an associated 1.05 increase in the risk of death (95% CI 1.02, 1.08) (p < 0.001). Overall median AAC value for all patients was 1784; Kaplan–Meier curve showed reduced survival of all‐cause mortality for patients with AAC score value above median and reduced survival among patients with cardiac related mortality. The iothalamate clearance was lower among patients with total AAC score value above the median. Patients with abnormal PP (< 40 or > 60 mmHg) had an elevated median AAC score value at 4319.3 (IQR 1210.4, 11097.1) compared to patients with normal PP with AAC score value at 595.9 (IQR 9.9, 2959.9) (p < 0.001). Conclusion We showed an association of AAC with patients’ survival and kidney allograft function after kidney transplant. The AAC score value could be used as a risk stratification when patients are considered for kidney transplant.
Objectives: We reviewed a consecutive series of patients who had arteriovenous fistula (AVF) placement in advance of starting hemodialysis and sought to determine what factors were associated with failure of the AVF to be ready for use, which required patients to start dialysis with a tunneled dialysis catheter (TDC).Methods: We analyzed all patients who had an AVF placed at our institution from 2013 to 2018 using data from the Vascular Quality Initiative database and retrospective chart review. The primary study group included patients who had an AVF placed in advance of needing hemodialysis. Patients were categorized as "Success": AVF placement with hemodialysis initiated using the AVF or "Failure": AVF placement with hemodialysis initiated using a TDC.Results: Of the 46 patients reviewed, 26 (56.5%) were classified as "Failure." Preoperative factors associated with failure included: uremia (5% of success group vs 26.9% of failure group; P ¼ .031), uremic males (37.5% of uremic male patients failed vs 0% of uremic females; P ¼ .007), history of coronary artery disease among males (success, 8.33% vs fail, 50%; P ¼ .04), and history of percutaneous coronary intervention among males (fail male, 25% vs fail female, 0%; P ¼ .030).Conclusions: In our series of patients referred for AVF placement prior to starting dialysis, we noted an unexpectedly high rate of hemodialysis initiation with a TDC. This study suggests that patientrelated factors such as uremia and a history of coronary artery disease or intervention may be associated with failure of the AVF to be ready for hemodialysis. Further work building from findings in this study may help with patient selection decisions to minimize the need to initiate hemodialysis with a TDC.
Introduction Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a form of temporary mechanical circulatory support commonly used during cardiothoracic interventions. Malperfusion during complex vascular procedures remains a significant risk that may potentially lead to multiple complications. Here, we report two cases highlighting the efficacy of VA-ECMO in both planned and emergent vascular interventions. Presentation of case In our first case, VA-ECMO was used to support an 82-year-old male during a high-risk thoracoabdominal aortic aneurysm repair. Our second case details an emergent pulmonary embolectomy in which VA-ECMO was used as a bridge to cardiopulmonary bypass. In both cases, the procedures were well-tolerated, and the patients were discharged 17 days postoperatively. Discussion VA-ECMO has been increasingly used as a form of post-operative circulatory support following cardiothoracic and vascular interventions. However, only few instances of perioperative VA-ECMO use have been reported in the field of vascular surgery. Conclusion The presented cases highlight that the perioperative use of VA-ECMO may be a viable modality for required perfusion during complex planned or emergent vascular procedures.
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